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Understanding CRNA Contributions to OB Care in Rural & Underserved Areas

Woman and man playing with baby boy on bed
Using mixed-methods evaluation and data linkage to study the experiences of certified registered nurse anesthetists (CRNAs)
  • Client
    American Association of Nurse Anesthetists Foundation
  • Dates
    December 2022 – May 2024

Problem

Many people seeking obstetric care in rural or underserved urban areas encounter barriers related to access.

Those in need of comprehensive, affordable, and high-quality obstetric care in rural and underserved urban areas encounter barriers related to workforce shortages, limited access to care and reduced quality of care. These women may encounter a lack of resource availability within their local hospital to care for them or their babies (i.e., a lack of a NICU or blood resources) or long travel times to get to a better resourced hospital.  

CRNAs are often the only specialists providing access to obstetric anesthesia services in rural hospitals, and studies show that they are more likely to practice in rural counties compared to anesthesiologists. They provide services in settings that often lack resource availability and staffing support. The aim of this study is to better understand how CRNAs are serving women residing in rural or underserved urban areas who need obstetric care. 

Solution

NORC is using mixed-method evaluation and data linkage techniques to understand the experience and impact of obstetric CRNAs in rural and underserved areas.

Through this project, NORC is conducting a provider survey of CRNAs using Voxco, which allows us to pre-populate hospital information and increases the reliability of hospital address data. NORC will then link CRNA responses to the survey, which will ask about the anesthesia model used at the hospital as well as experiences providing obstetric care to different types of patients. Linking survey data to the AHRQ SDOH database will allow us to describe the different communities being served by CRNAs in these hospitals, their demographic and risk profiles, and access to health care services.

NORC will also conduct a series of in-depth interviews to gather the stories of CRNAs working in rural and urban underserved areas and will explore the possibilities of linking T-MSIS claims data to the survey data to better understand how health outcomes are influenced by anesthesia models of care.

Result

Insights from our work will inform efforts to support obstetric CRNAs and mitigate barriers to care for their patients.

The aim of this project is to better understand the role that CRNAs are currently playing in rural and underserved urban areas to ensure that obstetric care is available to those who need it, and how that role may vary according to the anesthesia provider model of the hospital and other local factors. We also aim to understand how CRNAs can be better supported to continue providing obstetric services to those who need them.

Project Leads

“Having an available workforce to support those residing in rural and underserved areas when they are ready to deliver a baby is key to promoting equitable access to birthing services. We’ve learned through our research that CRNAs play a key role.”

Senior Research Scientist

“Having an available workforce to support those residing in rural and underserved areas when they are ready to deliver a baby is key to promoting equitable access to birthing services. We’ve learned through our research that CRNAs play a key role.”

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